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Neuroscience IV > TBI > Flashcards

TBI Flashcards

1
Q

What are the 3 levels of the cumulative glascow coma scale?

A

Mild: >13
Moderate: 9-12
Severe: <8

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2
Q

What are two surface signs of TBI?

A

Raccoon eyes or Battle’s sign, which is ecchymosis in the perauricular area beneath the mastoid.

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3
Q

What is coup contracoup?

A

The brain rebounding from a frontal impact to have a posterior impact.

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4
Q

Where does an epidural hematoma occur?

A

Between the dura and the skull.

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5
Q

Where does a subdural hematoma occur?

A

Between the dura and the arachnoid matter.

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6
Q

What does a subdural hematoma look like?

A

A crescent moon, not too wide at any location.

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7
Q

What happens during a diffuse axonal injury?

A

Trauma causes the axon to twist and tear, result in permanent death

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8
Q

What are the primary mechanisms of TBI injury?

A
  1. Contusion
    - direct trauma
  2. Bleeds
  3. Ischemia
  4. Laceration
    - tearing
  5. Diffuse Axonal Injury
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9
Q

What are the mechanisms of secondary injury?

A

Excitotoxicity:

  1. Excessive Ca++
  2. Excessive K+ efflux
  3. Reduced Mg

O2 free radicals
Cerebral edema (leaky BBB)
>ICP

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10
Q

At RLA level VIII, a patient only requires stand by assistance. What are the assistance levels and titles for I-VII?

A

TOTAL ASSISTANCE
I: no response
II: generalized response
III: localized response

MAX ASSIST
IV: confused-agitated
V: confused-innapropriate

MOD ASSIST
VI: confused appropriate

MIN ASSIST
VII: autonomous appropriate

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11
Q

What area of the brain (brain stem) governs awake consciousness?

A

Ponto-mesencephailc reticular formation.

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12
Q

How is a coma defined?

A

State of unarousable unresponsiveness in which there is no evidence of self or environmental awareness.

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13
Q

What are some clinical findings unique to coma?

A
  • no spontaneous eye opening
  • no sleep/wake cycle
  • behavior limited to reflexive activity
  • no localized responses or evidence of language comprehension
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14
Q

How is a vegetative state different than coma?

A

Wakefulness w/o arousal
-eye opening

  1. No voluntary behavioral responses to stimuli
  2. No language comp
  3. sleep/wake cycle
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15
Q

What acts does someone in VS perform that may be construed as partial consciousness (brainstem intact)?

A
  • grinding teeth
  • swallowing
  • smiling
  • crying
  • grunting
  • moaning
  • orienting
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16
Q

What is the timeline of VS?

A

Persistent VS = 4 weeks after initial VS

Permanent VS = 1 year after persisent.

17
Q

How is someone in a minimally conscious state different than a coma or VS?

A

Minimal, but definitive behavioral evidence of self or environmental awareness

  1. Follow simple commands
  2. Gesture yes/no
  3. Intelligible verbalization
  4. Movement or behavior that occur in response to stim
    - example of pt crying to same sad story
18
Q

How do you know someone has emerged from their MCS?

A

Demonstration of interactive communication or functional object use

  • at least 6 situational orientation questions
  • 2use 2 items on 2 different occasions
19
Q

What are the classifiers of being legally brain dead?

A
  • no evidence of function on clinical exam
  • no pain response
  • no cranial reflexes
  • no spontaneous respirations
  • flat EEG
20
Q

What is normal and dangerous ICP?

A 
Normal = 7-10 mmHg
>20 = shunt
>25 = life threatening
21
Q

What are good prognostic indicators of TBI?

A
  • GCS >8 in 24 hours
  • LOC <40
  • no drugs / alcohol
22
Q

Length of ___ is a measure of severity of injury

A

Post Traumatic Amnesia

23
Q

T/F: 20% of post TBI’s have post-traumatic epilepsy.

A

True.

24
Q

T/F: Cognitive changes are not the single most important predictor of disability after TBI.

A

False. They are.

Neuroscience IV (7 decks)

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